Optimal Stenting Strategy For True Bifurcation Lesions
- Conditions
- Coronary Artery Disease
- Interventions
- Procedure: Crush techniqueProcedure: provisional T stenting
- Registration Number
- NCT00693251
- Lead Sponsor
- Seung-Jung Park
- Brief Summary
It is unclear which stenting strategy will be optimal for true bifurcation coronary lesions.
- Detailed Description
The outcome of percutaneous coronary intervention of bifurcation lesions with bare-metal stents is hindered by increased rates of procedural complications and long-term major adverse cardiac events compared with non-bifurcated lesions.1 Randomized studies have demonstrated that drug-eluting stents reduce restenosis when used in relatively simple lesions; and recent data have demonstrated efficacy of the sirolimus-eluting stent for bifurcation lesions compared with historical data of BMS. In one study of bifurcation lesions, the overall restenosis rate was 23%, with the majority of side branch restenoses occurring at the ostium after use of a T-stenting technique. Indeed, side branch restenosis occurred in 16.7% after T-stenting, compared with 7.1% after other stenting techniques.
The "crush" technique of bifurcation stenting with DESs was introduced by Colombo et al. in 2003 as a relatively simple technique that ensures complete coverage of the side branch ostium, thereby facilitating drug delivery at this site. Initial data of 20 patients treated with this technique with SES suggest that it is a safe method, with an acceptable rate of procedural complications and no further adverse events up to 30 days follow-up. Recently, angiographic data have shown the importance of simultaneous kissing balloon post-dilation in reducing restenosis and need for target lesion revascularization. They also reported that compared to T-stenting, crushing with final kissing balloon dilatation was associated with lower rate of restenosis and target lesion revascularization. Consequently, the crushing is currently most promising technique in treating bifurcation lesions using two stents. However, despite the advance of bifurcation stenting technique, the superiority of bifurcation stenting with crushing technique over simple stenting in bifurcation lesion has not been demonstrated.
Therefore, we conducted the prospective randomized study comparing crushing technique with final kissing balloon dilatation and a simple technique (main vessel stenting and provisional T-stenting) for treatment of true bifurcation lesions.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 420
-
Clinical
- Patients with angina and documented ischemia or patients with documented silent ischemia
- Patients who are eligible for intracoronary stenting
- Age >18 years, <75 ages
-
Angiographic
- De novo lesion located in a major bifurcation point with the MEDINA classification type 1.1.0, 1.0.0, or 0.1.0
- Main vessel : >= 2.5 mm in vessel size, >= 50% in diameter stenosis and =< 50 mm in lesion length by visual estimation, in which the lesion seems to be covered with =< 2 stents
- Side branch : >= 2.0 mm in vessel size, >= 50% in diameter stenosis, and < 20 mm in lesion length by visual estimation, in which the lesion seems to be covered with single stent
-
History of bleeding diathesis or coagulopathy
-
Pregnant
-
Known hypersensitivity or contra-indication to contrast agent, heparin, sirolimus and paclitaxel
-
Limited life-expectancy (less than 1 year) due to combined serious disease
-
ST-elevation acute myocardial infarction < 2 weeks
-
Characteristics of lesion:
- Left main disease
- In-stent restenosis
- Graft vessels
- Chronic total occlusion
- TIMI flow =< grade 2 in the side branch
-
Renal dysfunction, creatinine >= 2.0mg/dL
-
Contraindication to aspirin, clopidogrel or cilostazol
-
LV ejection fraction =< 35%
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description bifurcation stent technique Crush technique crush technique bifurcation stent techniqe provisional T stenting provisional T stenting
- Primary Outcome Measures
Name Time Method Angiographic binary restenosis rate (diameter stenosis >= 50%) at 8 months in either main or side branch 8 months
- Secondary Outcome Measures
Name Time Method Influence of bifurcation angle 8 months Amount of contrast agent baseline FFR assessment in the side branch baseline and 8 months Influence of new three segment bifurcation QCA software 8 months Fluoroscopic time baseline Procedure time baseline Reocclusion rate at the side branch at 8 month angiographic follow-up 8 months Restenosis rate at the main vessel and/or side branch 8 months Number of used stents baseline Composite of major cardiac adverse events (MACE) including death, MI, stent thrombosis and ischemia-driven target vessel revascularization 2 years Late loss at the main vessel and the side branch 8 months
Trial Locations
- Locations (11)
Kyungsang University Hospital
🇰🇷Jinju, Korea, Republic of
Chungnam National University Hospital
🇰🇷Daejeon, Korea, Republic of
Soonchunhyang University Bucheon Hospital
🇰🇷Bucheon, Korea, Republic of
Hallym University Sacred Heart Hospital
🇰🇷Seoul, Korea, Republic of
Catholic University, Kangnam St. Mary's Hospital
🇰🇷Seoul, Korea, Republic of
Korea Veterans Hospital
🇰🇷Seoul, Korea, Republic of
Busan Saint Mary's Hospital
🇰🇷Busan, Korea, Republic of
Cheongju Saint Mary's Hospital
🇰🇷Cheongju, Korea, Republic of
Kangwon University Hospital
🇰🇷Chuncheon, Korea, Republic of
Ulsan University Hospital
🇰🇷Ulsan, Korea, Republic of
Aju University Hospital
🇰🇷Suwon, Korea, Republic of